Evaluation of relevant anatomy for cervical erector spinae plane block using paediatric computed tomography scans

The primary aim of this study was to provide foundational anatomical knowledge that may be valuable when performing a cervical erector spinae plane block (ESPB) with or without ultrasound guidance in a paediatric sample. This included measuring the distance from the spinous process to the tip of the transverse process at the C6 and C7 vertebral levels, the depth from the skin to the most medial points of the erector spinae muscle, and the most posterior points of the sternocleidomastoid muscle at the C6 and C7 vertebral levels. Ninety axial computed tomography (CT) images were randomly selected from the database of radiographic images at the Department of Radiology, Steve Biko Academic Hospital. The age and sex of the patients were recorded. The 90 axial CT scans consisted of 30 scans for each of the age groups defined by the American Medical Association, i.e., neonates (age range: 0-2 months), infants (age range: 2 months-2 years), and children (age range: 2-12 years). Gridlines were placed over the tips of the left and right transverse processes to ensure that points were perpendicular to the structure, and various measurements were taken bilaterally. Significant differences were observed between the majority of the measurements for the different age groups. Statistically significant differences were observed between the measurements for males and females in some instances. These results provide pediatric anesthesiologists with useful anatomical reference data when performing a cervical ESPB at vertebral level C6 or C7, particularly where ultrasound guidance is not available.